Digital Commons @ George Fox University Faculty Publications - Grad School of Clinical Graduate School of Clinical Psychology Psychology 1999 Aversion Therapy Rodger K. Bufford George Fox University, [email protected] Follow this and additional works at: https://digitalcommons.georgefox.edu/gscp_fac Part of the Counseling Commons, and the Psychology Commons Recommended Citation Bufford, Rodger K., "Aversion Therapy" (1999). Faculty Publications - Grad School of Clinical Psychology. 290. https://digitalcommons.georgefox.edu/gscp_fac/290 This Article is brought to you for free and open access by the Graduate School of Clinical Psychology at Digital Commons @ George Fox University. It has been accepted for inclusion in Faculty Publications - Grad School of Clinical Psychology by an authorized administrator of Digital Commons @ George Fox University. For more information, please contact [email protected]. Aversion Therapy ferred to as the "hot seat." The basic difference is ance. Often escape training is used initially, then in application. Psychodramatists encourage the pro­ modified into avoidance training. tagonist to confront persons, things, and self. The In escape training the target stimulus is pre­ Gestalt therapist uses the hot seat to help the client sented; then an unpleasant stimulus such as electric encounter parts and dimensions of the self. shock occurs. After brief exposure to the two stimuli, the individual escapes from the stimuli by making J. H. VANDER MAY a specified response. For example, a transvestite is given an article of women's clothing to put on and See GESTALT TECHNIQUES; GESTALT THERAPY. then administered electric shock. Once the clothing is removed, shock is terminated. Aversion Therapy. Aversion therapy uses anumber In avoidance training the individual is presented of techniques and stimuli to weaken or eliminate with the stimulus that elicits the problem behavior. undesirable responses such as deviant sexual behav­ If an avoidance response is made quickly enough, ior and substance abuse. In theory punishment is the aversion stimulus is avoided. The avoidance re­ used to directly reduce the frequency of undesired sponse typically removes the stimulus for the un­ behaviors through contingent presentation or removal desired response. For example, turning off pictures of a stimulus, while aversion, or aversive counter­ of women's clothing quickly enough may avoid conditioning, seeks to change the undesirable re­ shock for a fetishist. An advantage of the avoidance sponse indirectly by altering the functions of the dis­ procedure is that the client learns to be anxious in criminative and reinforcing stimuli. In practice this the presence of the target stimulus and is positively distinction is somewhat blurred, since many aver­ reinforced for actively avoiding it. sion procedures have both punishing and stimulus­ Covert sensitization is a form of aversive coun­ altering effects. terconditioning in which the client imagines an un­ In some forms of aversion, no behavior need oc­ pleasant event following the undesired stimulus re­ cur. Rather, the discriminative and reinforcing stim­ sponse complex rather than experiencing overt uli that maintain the problem behavior (e.g., sight aversive stimulation. For example, persons may or smell of alcohol, deviant sexual stimuli) are pre­ imagine taking a large bite of hot fudge sundae sented to the person, and an unpleasant stimulus topped with whipped cream and nuts and then imag­ (e.g., electric shock) is presented simultaneously. ine becoming grossly fat, unable to fit into their The discriminative and reinforcing stimuli acquire clothes, and socially ostracized. In the avoidance the properties of the aversive stimulus through as­ phase they imagine becoming increasingly anxious sociation. The goal is to weaken the link between as they approach the ice cream shop. They then imag­ the controlling conditioned stimulus (e.g., children) ine turning away and experiencing immediate relief. and undesired response (e.g., sexual arousal). Effectiveness ofAversion. Research on the out­ Wolpe's theory of reciprocal inhibition provides one comes of aversion treatments has produced mixed explanation for this process. Wolpe theorizes that results. Aversion is quite effective with transvestism arousing a strong competing response such as nau­ and fetishism. Aversion techniques are the most com­ mon approach to treatment of pedophilia. Aversion sea or fear inhibits the undesired response. with sexual reconditioning has shown favorable Aversion uses electrical shock; chemical and ol­ short-term effects with pedophiliacs, but reductions factory stimuli such as emetine hydrochloride oflong-term recidivism have not been demonstrated. (which causes nausea and vomiting); valerie acid Results with homosexuality are modest; they are bet­ (which smells like rotten eggs) and ammonia; covert ter for homosexuals voluntarily seeking treatment sensitization by aversive imagery; and shame induc­ and for those with prior heterosexual experience. tion (McAnulty & Adams, 1992). The ideal stimulus Aversion has been found effective with transvestites is one that permits rapid onset, prompt termination, and fetishists with prior heterosexual experience; controlled intensity, and quick recovery so that re­ and a few gender identity problems also show fa­ peated trials may be administered in a brief time. vorable outcomes (McAnulty & Adams, 1992). Electric shock and noxious smells are readily con­ The effectiveness of aversion with sexual devia­ trolled in these ways, but drugs are not. Drug ad­ tions is influenced by a number of factors. Most ministration also requires medical personnel and studies have used electrical aversion; smell aversion sometimes hospitalization, is medically contraindi­ shows promise and has been widely adopted but cated for many individuals, and may have side ef­ needs further study. Although drug aversion studies fects that impair conditioning. Shock is widely ap­ have sometimes yielded promising results, shock plicable except for persons with heart conditions. and unpleasant smells are more commonly used For all these reasons shock replaced drugs as the with sexual behaviors. A major concern with sexual principal aversion technique in the 1970s. More re­ disorders is the need to assess sexual arousal to ap­ cently covert sensitization has become preferred. propriate heterosexual stimuli. When appropriate Aversion takes three basic forms: escape training, sexual arousal patterns are absent or weak, devel­ avoidance training, and presenting the unpleasant oping or strengthening them is essential to lasting stimulus without permitting either escape or avoid- effects of aversion. 115 Aversion Therapy Electrical aversion does not appear effective for and express love, especially God's love, may be the alcohol abuse. Nausea aversion is generally effective key. for several months, but as time passes an increasing Reorientation treatment of homosexual behavior percentage of clients resume drinking. Compliance is highly controversial and is not widely practiced. may be as low as 20% when voluntary; thus admin­ Since 197 3 homosexuality has not been considered istration in a supervised setting is important. Addi­ a mental disorder by the American Psychiatric As­ tional treatment of psychosocial problems is widely sociation. Some contend that any sexual reorien­ recommended and may help to maintain gains. In tation treatment is abusive, a result of homopho­ a recent review Emmelkamp concludes "aversive bia-fear of and hostility toward homosexuality. therapy, if applied at all, should be part of a more Others, such as Nicolosi (1991), contend that reori­ comprehensive cognitive-behavioral program" (Em­ entation treatment can be ethically conducted melkamp, 1994, p. 400). within the guidelines of informed consent when it Covert sensitization is appealing for both theo­ is consistent with the values and goals of the indi­ retical and practical reasons. Covert sensitization vidual seeking treatment. appears promising for those who can visualize well Summary. Aversion therapy uses aversive coun­ and are well motivated. However, there remains a terconditioning and covert sensitization to eliminate lack of clear empirical evidence of treatment effec­ undesired behaviors. Research indicates that aver­ tiveness for covert sensitization when it is used sion is effective for some problems and under some alone. Thus it should be used as part of a more com­ conditions. Because of legal, ethical, and practical prehensive approach that also addresses the psy­ concerns, covert sensitization has gradually become chosocial aspects of the problem behavior. Adams the preferred approach, at least for outpatient psy­ notes that a number of biblical teachings are con­ chotherapy. Empirical support is limited for covert sistent with the idea of replacing responses rather sensitization alone but indicates that more compre­ than simply eliminating them (Adams, 1973). hensive treatment packages that include covert sen­ Ethical Issues. Aversion therapy has often been sitization along with strengthening of desired alter­ opposed on ethical and moral grounds. However, native responses are quite effective. The precise aversive consequences are a natural feature of the contribution of covert sensitization in these treat­ social and physical world. Behaviors treated by aver­ ment approaches is not known. Finally, as applied sion usually produce immediate rewards followed to sexual behavior, aversion